1964例原发性支气管肺癌的外科手术经验

The experience of surgical resection in 1964 cases of primary bronchogenic carcinoma

目的 总结 1964例原发性支气管肺癌的外科手术经验。方法 对 1964例肺癌患者 (中心型 114 0例 ,周围型 82 4例 )的临床和病理资料进行回顾性分析。结果 全组手术切除共 162 6例 ,切除率为82 .8% ,其中全肺切除 160例 ,肺叶切除 13 86例 ,支气管袖状成形肺叶切除 70例及支气管楔形成形肺叶切除10例。术后发生并发症 2 94例 ;死亡 2 0例 ,手术死亡率为 1.0 % ( 2 0 /1964 )。对手术中常见的疑难病例处理进行了分析。结论 手术为肺癌的主要治疗方式之一。若遇左上肺癌浸润和包绕左肺动脉干 ,应先阻断肺动脉根部 ,再分离被浸润的上叶肺动、静脉并予结扎切断 ,然后切除有肿瘤的左上叶 ,最后清除血管壁上残余的癌组织。中晚期中心型肺癌以及肺动、静脉根部距肿瘤距离太短 (≤ 0 .5cm)的病例应行心包内结扎肺血管。右上肺癌浸润和包绕上腔静脉和右肺动脉干者可先结扎并切断奇静脉 ,然后轻轻向前外牵拉上腔静脉并小心分离。对肺门冻结者可先处理主支气管 ,然后处理肺动静脉。

Objective To summarize the experience of surgical resection of primary bronchogenic carcinoma (PBC). Methods We reviewed the clinicopathologic data of 1?964 cases of PBC. There were 1?140 central type and 824 peripheral type. Results Among them, 1?626 cases (82.8%, 1?626/1?964) were given successive resection, in which 160 cases were total pneumonectomy, 1?386 cases were lobectomy, 70 cases were sleeve lobectomy, and 10 cases were wedge resection. Two hundred and ninety four cases had various postoperative complications and 20 cases died. The operative mortality was 1.0%(20/1?964). Managements of problems encountered in operation were discussed in this paper.Conclusion Surgical resection is a better apporach in the treatment of PBC. Left upper lung cancer invading and surrounding the pulmonary artery trunk requires blocking the pulmonary artery root first, then separating the invaded blood vessels and resecting the tumor and upper pulmonary lobe, lastly dealing with the remained cancer tissues. For patients with intermediate and advanced lung cancer, if the root of pulmonary artery and vein almost attaches to the tumor, intrapericardial blood vessels ligation should be performed. When the right upper lung cancer invades and surrounds the superior vena cava and the upper pulmonary artery trunk, we should cut and ligate the azygos vein first and draw the superior vena cava gently towards front outside and dissect carefully. If the tumor, hilar, mediastinal and associated lymph nodes mix together to form the frozen hilar, we should deal with the main bronchus first, then the pulmonary artery and vein.